169154 02/17/2009 CITY OF CARMEL, INDIANA VENDOR: 356934 Page 1 of 1
ONE CIVIC SQUARE SIGNATURE CONSTRUCTION LLC
i
CARMEL, INDIANA 46032 720 3RD AVE SW CHECK AMOUNT: $9,514.52
'�rono �i CARMEL IN 46032 CHECK NUMBER: 169154
CHECK DATE: 2/17/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460867 3 9,514.52 INDIANA DESIGN CENTER
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT 6702 PAGE ONE OF I PAGES
"1'0 OWNER: Carmel Redevelopment Commission PROJECT: Parcel 67 APPLICATION NO: Draw Number #3 1 Distribution to:
One Civic Square City Project 26236 Signature costs =OWNER
Carmel, Indiana 46032 Robert Indiana Street Work =ARCI-11 i'l CT
PERIOD TO: 12122/08 C]CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT:
Signature Construction LLC
720 3rd Avenue S.W. PROJECT NOS:
Carmel, Indiana 46032
CONTRACT FOR: CONTRACT DATE: October, 2008
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,
Application is made for payment, as shown below, in connection with the Contract. information and belief the Work covered by this Application for Payment has been
Continuation Sheet, AIA Document G703, is attached. completed in accordance with the Contract Documents, that all amounts have been paid by
the Contractor for Work for which previous Certificates for Pavment were issued and
payments received from the Owner, and that current payment shown herein is now due.
I. ORIGINAL CONTRACT SUM 30,460.00
2. Net change by Change Orders 0.00 CONTRACTOR:
3. CONTRACT SUM "f0 DATE (Line 1 t 2) 30,460.00
4. TOTAL. COMPLETED STORED TO DATE 18,764.66
By: f Date:
5. RETAINAGE- Tom Kodntz President
a. 0 of Completed Work Subscribed 1 d sworn before me this /day of
(Column D E on G703)
b. of Stored Material
(Column F on G703)
Total Retainage (Lines 5a 5b or
Total in Column I ofG703) 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT
6. TOTAL, EARNED LESS RETAINAG]" 18,764.66 In accordance with the Contract Documents, based on on -site observations and the data
(Line 4 Less Line 5 Total) comprising the application, the Architect certifies to the Owner that to the best of the
7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work has progressed as indicated,
PAYMFNf (L.ine 6 Iron prior Certificate) 14,604.46 the quality of the Work is in accordance with the Contract Documents, and the Co_ ntractor
8. CURRENT PAYMENT DUE 4,160.20 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH_ INCLUDING Rl•I'AINAGE 11,695.34
(Line 3 less Line 6) AMOUNT C 4.160.20
CEIANGI. ORDER SUMMARY ADDITIONS DEDUCTIONS (411ach planation amou certified diers from the amount applied. Initial all figures on this
Total changes approved Applic lion and o the nii it eel that are changed to conform with the amount cert fed.)
in revious months by Owner ARCI TECT.
Total approved this Month By Datc: I (7-4
TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
contractor named herem. Issuance, payment and acceptance of payment are without
NET CI L4NG1 5 by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702 APPLICATION AND CERTIFICATfON FOR PAYMENT 1992 EDITION AIA ®1992 THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NEW YORK AVE., N W., WASHINGTON, DC 20me -5292
Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee.
s
City of Carmel
Parcel 67 Streetscape Indiana Design Center P12
City Project Number 26236 Robert Indiana Street Work
Budget Review and Distribution Request #3
Period Ending January 23, 2009
PROJECT BUDGET REVIEW SUMMARY
TOTAL WORK THIS PERIOD Current BALANCE Total
Scheduled COMPLETED RETAINAGE Payment PREVIOUS TOTAL COMPLETED TO Retainage
DESCRIPTION Value THIS PERIOD WITHHELD Due APPLICATIONS TO DATE FINISH Held
General Conditions /Requirements 46,150.00 11,537.50 1,153.75 10,383.75 23,075.00 34,612.50 75% 11,537.50 3,461.25
Existing Conditions /Selective Demo 8,770.00 0.00 0.00 0.00 8,770.00 8 770 .00 100% 0.00 877.00
Concrete 24,430.00 2,443.00 244.30 2,198.70 9 772 .00 12,215.00 50% 12,215.00 1,221.50
Meltal 2,190.00 328.50 32.85 295.65 1,314.00 1,642.50 75% 547.50 164.25
Specialties (signage) 5,570.00 0.00 0.00 0.00 0.00 0.00 0% 5,570.00 0.00
Electrical 41,640.00 8,328.00 832.80 7,495.20 16, 656.00 24,984.00 60% 16,656.00 2,498.40
Earthwork 41,500.00 6,225.00 622.50 5,602.50 24 900 .00 31,125.00 75% 10,375.00 3,112.50
Exteriorlmporvements 70,650.00 0.00 0.00 0.00 10,597.50 10,597.50 15% 60,052.50 1,059.75
Utilities 63,700.00 12,740.00 1,274.00 11,466.00 50,960.00 63,700.00 100% 0.00 6,370.00
Signature's General Conditions 15,230.00 2,080.10 0.00 2,080.10 7 302.23 9,382.33 62% 5,847.67 0.00
Si nature's Profit Overhead 15 230.00 2,080.10 0.00 2 7 9 62% 5 0.00
Total 335,060.00 45,762.20 4,160.20 41,602.00 160,648.96 206,411.16 62% 128,648.84 18,764.65
Prescribed State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Z_L Purchase Order No.
7 2G moo �vP. Terms
Z Date Due
Invoice Invoice Description Amount
Dat Number (or note attached invoice(s) or bill(s))
2 2'/a8 3 7 G, Zo
Total L/ zQ
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
S i��i Q vr� �oo5�r ✓��b�r, LL C
IN SUM OF
72 O
'��O 3 Z
y /G0 -zG
O ACCO PROPRIATION FOR
Board Members
or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
god 3 �yGOF6 7 4'160, z.6 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
20&
Signature
1�'
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENTG702 PAGE ONE O I PAGES
TO OWNER: Cannel Redevelopment Commission PROJECT: Parcel 67 APPLICA'T'ION NO: Draw Number #3 1 Distribution to:
One Civic Square City Project 26236 Signature costs =OWNER
Carmel, Indiana 46032 Rangeline StreetScapes
=ARCHITECT
PERIOD TO: 12/22/08 =CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT:
Signature Construction LI.0
720 3rd Avenue S.W. PROJECT NOS:
Carmel. Indiana 46032
CONTRACT FOR: CONTRACT DA'Z'E: October, 2008
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,
Application is made for payment, as shown below, in connection with the Contract. information and belief the Work covered by this Application for Payment has been
Continuation Sheet, AIA Document G703, is attached. completed in accordance with the Contract Documents. that all amounts have been paid by
the Contractor for Work for which previous Certificates for Payment were issued and
payments received from the Owner, and that current payment shown herein is now due.
L ORIGINAL CONTRACT SUM 29,382.20
2. Net change by Change Orders 0.00 CONTRACTOR:
3. CONTRACT Sum 1 DATE (Line I t 2) 29,382.20
4. 1'0 "1 COMPI_L:TED R S1 DA "I'E 16,222.82
By: Date: 2
5. RETAINAGE 1'om k tz PresXen, Z11
a. 0 of Completed Work S scribed d sworn to before in day of
(Column D li on G703)
b. of Stored Material
(Column F on G703)
Total Retainage (Lines 5a 5b or
Total in COIUmn I ofG703) 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 16,222.82 In accordance with the Contract Documents, based on on -site observations and the data
(Line 4 Less Line 5 Total) comprising the application, the Architect certifies to the Owner that to the best of the
7. LESS PREVIOUS CERTIFICATE'S FOR Architect's knowledge, information and belief the Work has progressed as indicated.
PAYMENT (Line 6 from prior Certificate) 10,868.50 the quality of the Work is in accordance with the Contract Documents. and the Contractor
8. CURRENT PAYMENT DUI: 5,354.32 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCF. TO FINISI1. INCLUDING RETAINAGE 13,159.38
(Line 3 less Line 6) AMOUNT CERTIFIED 5.354.32
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differsfrom the amount applied Initial all figurer on this
Total changes approved Application and onthe Continuation Sheet that are changed to conform with the amount certified)
in previous months by Owner ARCHITECT:
Total approved this Month By: Date:
TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein. Issuance, payment and acceptance of payment are without
NI T C I IANGFS by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA .(01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE.. N.W WASHINGTON, DC 20006 -5292
Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee.
City of Carmel
Parcel 67 Streetscape Indiana Design Center P12
City Project Number 26236 Rangeline Streetscapes
Budget Review and Distribution Request #3
Period Ending January 23, 2009
PROJECT BUDGET REVIEW SUMMARY
TOTAL WORK RETAINAGE Current BALANCE Total
Scheduled COMPLETED WITHHELD Payment PREVIOUS TOTAL COMPLETED TO Aetainage
DESCRIPTION Value THIS PERI THIS PERIOD Due APPLICATIONS TO DATE FINISH Held
General Conditions /Requirements 56,800.00 14,200.00 1,420.00 12,780.00 28,400.00 42,600.00 75% 14,200.00 4,260.00
Existing ConditionslSelective Demo 13,150.00 0.00 0.00 0.00 13 ,150.00 13 ,150.00 100% 0.00 1,315.00
Concrete 36,700.00 16,515.00 1,651.50 14 863.50 9,175.00 25 690.00 70% 11,010.00 2,569.00
Meltal 6,580.00 1,579.20 157.92 1,421.28 3,026.80 4,606.00 70% 1,974.00 460.60
Specialties (signage) 8,350.00 0.00 0.00 0.00 0.00 0.00 0% 8,350.00 0.00
Electrical 57,950.00 5,795.00 579.50 5,215.50 2,897.50 6,692.50 15% 49,257.50 869.25
Earthwork 22,420.00 11,210.00 1,121.00 10,089.00 6,726.00 17,936.00 80% 4,484.00 1,793.60
Exteriorlmporvements 46,980.00 0.00 0.00 0.00 9,396.00 9,396.00 20% 37,584.00 939.60
Utilities 21,220.00 4,244.00 424.40 3,819.60 16,976.00 21,220.00 100% 0.00 2,122.00
Change Order #1 23,672.00 0.00 0.00 0.00 18,937.60 18,937,60 80% 4,734.40 1,893.76
Signature's General Conditions 14,691.10 2,677.16 0.00 2,677.16 5,434.25 8,111.41 55% 6,579.69 0.00
Signature's Profit Overhead 14,691.10 2 0.00 2 5 8 55% 6,579.69 0.00
Total 323,204.20 58,897.52 5,354.32 53,543.20 119,553.40 178,450.92 55 °l° 144,753.28 16,222.81
I
~Prescribcd by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
T,�V �L Purchase Order No.
72 31-0/ �v�°wP S.�/, Terms
C'a�� Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
l 5111 r,,f5 /�q G 51
Total S 3S S'.32
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
f'
'Si,9r'��s�a�y c.- Gr�3��o�a7 L LC IN SUM OF
3 2
-3
ON ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or DEPT INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
}02 3 7 53Sy,32- bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
20
Signatu e
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund